We know phishing scams are getting more sophisticated. It’s the age old story – target the vulnerable. Mostly the vulnerable are the cognitively disabled, including the ever growing population of once sophisticated adults with new pre-dementia. (Emerging trend: children filtering their parent’s email.)

There are other vulnerables though. People facing medical or financial crises, where desperation trumps judgment. Or people with a missing loved one.

Recently I received a phishing email promising information on my brother. It wasn’t all that well done (no, I won’t point out how the scum could improve); I presume it was an amateurish attack from some online registry.

Ironically, the crooks did me a favor. They made me check the old domain I setup years ago. I was shocked to find it pointing to my hosting service – Lunarpages. Turns out a credit card had expired, and the registration had lapsed. Lunarpages still held the domain, so once I fixed the card they restored the service. (Now I have to figure out what happened to their missing notifications, and whether I want a different host.)

So here’s a thanks to the scum-sucking lice running phishing scams against the families of disappeared persons. You did me a good turn. Tell me where you live, and I’ll return the favor …

Name a drugmaker that isn’t struggling to come up with breakthrough medicines. Research costs have ballooned while output at many companies has slowed to a trickle. Technology that was supposed to make drug research more predictable seems to have instead made it easier to come up with more drug failures faster.

“The molecular revolution was supposed to enable drug discovery to evolve from chance observation into rational design, yet dwindling pipelines threaten the survival of the pharmaceutical industry,” say consultant David Shaywitz and Nassim Nicholas Taleb, author of “The Black Swan: The Impact of the Highly Improbable.”

“What went wrong?” they ask in the opinion pages of the Financial Times. “The answer, we suggest, is the mismeasure of uncertainty, as academic researchers underestimated the fragility of their scientific knowledge while pharmaceuticals executives overestimated their ability to domesticate scientific research.”

When you get right down to it, Shaywitz and Taleb say, we still don’t understand the causes of most disease. Even when we think we do, because someone found a relevant gene, we’re not very good at turning the knowledge into a treatment. “Spreadsheets are easy; science is hard,” they tell Big Pharma…

Lots of failed immune related drugs re-purposed with limited focal impact on a few disorders.

Probably some improvements in seizure meds. Lots of new Parkinson’s and diabetes meds, but they’ve had limited value. (metformin was a home run, but that was more than 7 years ago).

Really lousy progress in antibiotics; there are fewer useful therapies now than 7 years ago. Actually, fewer every year.

Every so often I read stories about how physicians are demoralized by financial pressures or lack of social support. I can see that, but maybe we should start asking real physicians (not industry types like me) if they’re feeling discouraged by the lack of medical progress.

It’s a lot more fun to practice medicine when you’re able to do new things to help people, not so much fun when there’s no more magic in the hat …

PayPal, about a hundred years late, has established a signed email infrastructure. I don't see PayPal/eBay phishing scams on Gmail any more, because anything unsigned is instantly deleted.

So they're trying to clean up a bit. Too late for me. They played a dirty game too long - I want 'em gone.

I thought Google Checkout would do the trick. Much as I like Checkout though, Google hasn't done that much with it. (Given a choice, I usually choose a Google Checkout vendor.) In particular Checkout never went person-to-person, and it never went international.

Simple Pay is very much like Google Checkout (confusingly, Amazon Checkout is more like a store front service). It's business oriented, but I went through part of the signup and it's trivial -- any individual proprietor could easily use Simple Pay.

Simple Pay is also available for non-profit donations (so is Google Checkout, but we couldn't get that to work for MN Special Hockey). Here's their cut:

For Transactions >= $10:

2.9% + $0.30 for all transactions

For Transactions < $10:

5.0% + $0.05 for all transactions

Amazon payments is even more interesting. It allows phone-to-phone cash transfers and online cash transfers to any person.

I signed up. I can now send money to "anyone's" (I suspect they really mean "anyone in the US") email or phone, it goes against my regular credit card.

Update: You might want to wait a bit before using Amazon Payments. I, of course, found a bug. Amazon Payment has assigned me the name of a corporate admin who's card was a available for my use in my Amazon account. That card was never my primary payment card, and it's not been used for ages, but it was there. Extremely annoying. I've deleted it and remove the name from my address book, but the identity assignment remains. I'll update this note with Amazon's response.

It took me quite a few emails until Amazon stopped sending me automated, useless, support responses. Sadly, I had to resort to one of those upper case, exclamation point, adjective infested "YOU HAVE A BUG!!!!" emails. Modern email decision support systems treat these the same way voice recognition systems treat obscenities -- they route to a human.

That's so sad.

This is what Amazon finally responded with:

I have reviewed our previous correspondence with you, and I offer my sincere apologies for any misunderstanding thus far.

I'm sorry to hear about the difficulty you experienced with the name on your Amazon Payments account.

At this time, I do see that the name listed for your Amazon.com account is John G Faughnan, and your Flexible payments account may be showing as xxxxx.

We are aware that the Payments website may greet you by the name associated with a credit card rather than the name on your Amazon.com account. I have passed this feedback along to our developers. We are always happy to get this type of feedback from our members.

We will update the display name for your Amazon Payments account for you. This change should be completed within 1-2 weeks.

Please be assured that in the meantime your Payments account will operate correctly in spite of the name difference...

The problem arose because one of the credit cards on my Amazon account belonged to a corporate admin, that happened to be the name Payments randomly picked for a "greeting name".

Update 8/19/08: Amazon has some support issues. Either that, or their outsourced support organization is suffering from very high levels of turnover.

Today's episode:

I reviewed your Payments account and saw that the name associated with credit card on the account is "xxxxxxxxxxxxx" and the one associated with Amazon Payment is "yyyyyyyyyyyyyy". Please advise which one needs to be changed/updated on the account.

As always, please feel free to contact us should you have future questions or comments. If you need to contact us back, you can do so by using the secure form at the following specialized link to assure we receive your message:

Of course all my prior correspondence was clear on which was the correct name, and, as noted above, there's no way to respond to the message.

.... The use of joint registries has proven beneficial abroad. In Australia, regulators use such data to force manufacturers to justify why poorly performing hips or knees should remain available, and products have been withdrawn as a result. In Sweden several years ago, surgeons alerted by their national registry stopped using a badly flawed hip long before their American counterparts did. A few medical organizations here, like Kaiser Permanente, operate their own registries to good effect and the Hospital for Special Surgery in New York has recently set up a registry....

If I were the governor of MN, I'd use the Swedish and Kaiser registries. How big a registry do we really need?

The NYT story incidentally illustrates how corrupted we physicians are. The physician profiled received lots of money from the hip replacement vendor. He eventually bit the hand that fed him, but we have lots of experimental data to show that paying "consultants" delays or softens any potential "bites".

In the absence of a national registry, or the use of Swedish and Kaiser data, paying off surgeons is a good investment. Not as great an investment as funding a helpful Senator's reelection, but pretty good.

QM seemed to restore free will, but it introduced some disturbing predictions of its own. Physicists attempted to restore the concept of an observer-independent reality through the transactional interpretation, but that did in free will

On July 3, news reports said Senator John McCain, worried that he might lose the election before it truly started, opened his doors to disciples of Karl Rove from the 2004 campaign and the Bush White House. Less than a month later, the results are on full display. The candidate who started out talking about high-minded, civil debate has wholeheartedly adopted Mr. Rove’s low-minded and uncivil playbook...

Obama is a Chicago pol, so this can't be unexpected. We know the low road works on Americans.

I expect the GOP to win. I suppose it's the result of 8 years of Bush -- I really can't imagine a better future.

I love it. They'll have time to build out more content -- it will be months before MobileMe is reliable (assuming Apple can do reliability, which is unclear), and a year before it's a real competitor to Google Apps.

... The ideas aren't quite as novel as Gawande suggests. I recall fifteen years ago veteran physicians, with lots of experience with intractable pain and chronic fatigue, had begun to think the problems were 'all in the patient's head'. By which we meant, with intentional irony, that the problem was 'malwiring' of the brain.

The good news is, the brain is plastic. We can't easily alter it directly, but we can slowly reprogram it through the mind. That's how the mirror-box therapies Gawande describes work, and presumably that's how exercise therapy works for chronic fatigue syndrome (albeit both imperfectly)...

Ok, I have to also thank my son, who has an extremely tight connection between psyche and soma. I watched a recent shoulder problem wax and wane in proportion to psychic stress, and I realized what's wrong with both my tag and my prior post.

I have too strong a division in my own head between the central and peripheral nervous system. Yeah, sure, everything is connected to everything else so we do need to draw lines, but I think for the purposes of modeling disorders of sensation and perception, including pain, the line should be drawn around the peripheral nervous system -- not around the central nervous system (and not around the body -- that's too broad to be conceptually useful).

Perception and sensation are core functions of mind, and we physicians may err in ascribing them primarily to the periphery or the core.

Yes, I know this seems self-evident when I put it this way. Maybe it is, but I think there's something here. If we truly believed in this model, I think we would approach all management of sensation, whether arising in a broken leg (peripheral nervous system), or my son's sore shoulder (central and peripheral) or intractable itching (central) with an eye to techniques applied both peripherally (set the leg) and centrally (??).

There's something here ... I just need to think about it a bit more.

[1] More or less, without the "oxygen" of social interaction and coherent sensory input it won't run well for long.

Sunday, July 27, 2008

This stuff is extremely hard, but Apple has brains and money. What in their culture caused such a massive screw-up?

The problem, I think, is secrecy -- an obsession with surprises that comes partly from their CEO (though if I read one more article claiming Jobs is Apple my brain will explode), partly from their history, and largely from an insanely successful marketing strategy.

The complexity of changing a densely interconnected system like .Mac to a very different system like MobileMe requires months of public beta before launch. There can't be any surprises, there has to be high reliability.

Google gets this. Microsoft gets this.

Apple doesn't.

Apple won't be able to compete in the (cursed) Cloud if they can't kill their secrecy demon.

Saturday, July 26, 2008

... One issue we encountered was a mail outage affecting 1% of our members. Last Friday a serious problem with one of our mail servers blocked those members’ access to their MobileMe mail accounts. As of today a team was able to restore limited web access to those accounts so the affected members can use their browsers to read mail that has arrived since last Friday (though not before) as well as send and receive new mail. The team has already begun rolling out restoration of full access for all the accounts and expect to finish by the end of next week. We particularly regret to report the loss in the affected accounts of approximately 10% of the messages received between July 16 and July 18.

.... fixed over 70 bugs including one that was preventing MobileMe IMAP mail folders from syncing correctly between the web app and Mac OS X Mail or Outlook, plus others correcting display issues in Calendar and in general enhancing the performance of our web apps...

... Yahoo did its best to stage a rival to Apple Inc.'s iTunes, but after three years of lagging results, the Internet icon is putting its Yahoo! Music service to rest and leaving subscribers with copy-protected music libraries that can't be transferred to new computers...

When Microsoft/MSN (? or was it AOL?) did something similar I think they refunded customer money, though that only works for people with current accounts.

They key lesson is that when you buy a used CD for $3 you have access to that material for an unlimited amount of time. When you buy the same CD new on iTunes for $14 you have use until Apple closes its FairPlay servers, or until it changes your iTunes contract.

We live in an age of transience. I suspect a younger generation will simply accept this as the way things are.

Incidentally, there's a cruel surprise slowly being uncovered. A surprise, that is, to the vast majority of people who don't bother thinking about DRM.

[1] There used to be a workaround for non-DRMd iTunes media, but I've not tested it on iTunes 7.7. Sooner or later Apple will close the door on this; my transient DRM optimism has faded. I don't think Americans are going to figure this one out. Maybe the EUs will twig to this, and put some serious laws in place.

Update: Recently Apple terminated its .Mac web page authoring tools. All .Mac web pages are now inaccessible. For a scary moment I thought Google had done the same thing with my old Google Pages. Turns out they're only close to gone. Dang, but I sure as shootin' don't trust that cloud.

Friday, July 25, 2008

…Continuing my review of I Am a Strange Loop, today I get to tackle metamathematics. Hofstadter tackles it too, and finds it rich in philosophic insight. Strangely rich, actually.

I suppose I ought to explain who Kurt Gödel is and why he is a hero of many, many nerds today (I am among those ranks). And that tale doesn't start with Gödel, so stay patient while I explain the background…

Caustic and opinionated, but interesting. I started to look at the archives. Should I grab this feed?

Then I saw the “links of note”: national review, weekly standard, rush… savage … beck …

On closer inspection, the stranger in the night wears a necklace of human noses.

Backing slowly away …

Thank heavens for the link list – who knows what horrors I might have been exposed to!

... So if Bayes' Theorem seems unobjectionable, then I want to make you feel queasy about it. That's my goal. The way to do that is to take the theorem very, very seriously as an account of how we should reason about the state of the world...

… a strange note showed up on the MobileMe support Web site: “1% of MobileMe members cannot access MobileMe Mail. We apologize for this service interruption and are working hard to resolve the problem.”

Now, even if 1 percent is accurate, Apple has 2 million .Mac/MobileMe customers. So that’s at least 20,000 people…

… For most of them, the e-mail features of MobileMe just don’t work. The online Mail program at Me.com shows up empty; mail you try to send from your e-mail program never goes out; and messages sent to you get bounced.

For a few, it’s a lot worse. “This morning, I woke up and turned on my computer,” wrote one reader. “Happily, it seemed that the MobileMe e-mail service was back up. However, a few seconds later, when my computer synced with .Mac/MobileMe, ALL of my e-mail — every single e-mail I’ve ever sent, received, and filed on .Mac — disappeared. Every e-mail file on my hard drive (in the Mail library) was gone. I immediately went to Me.com to make sure that all my e-mail was still saved to Apple’s server. It wasn’t. All of the mail was gone.”

Apple escalated her case and dedicated top technicians to it, for which she was grateful. In the end, however, they recovered only 43 messages. The rest are gone forever…

… MobileMe tech support, my correspondents tell me, is nearly impossible to reach; the recording says that the support team is “unavailable due to the overwhelming interest in MobileMe.” (Somehow I doubt that “overwhelming interest” is the problem.) When you do reach them, they’re apologetic but can do nothing to help.

…the real problem is how Apple is responding. For a company that’s so brilliant at marketing, it seems to have absolutely no clue about crisis management…

…This is an airplane that’s stuck on the runway for hours with no food or working bathroom. And the pilot doesn’t come on the P.A. system to tell the customers what the problem is, what’s being done to fix it, how much longer they might be stuck, and how he empathizes with their plight. Instead, he comes on once every three hours to repeat the same thing: “We apologize for the inconvenience.”…

I wonder if people who’ve lost all their email have grounds for litigation. A nice class action suit might concentrate Apple’s mind. I also wonder how many of the victims are running an older version of OS X desktop (ex. 10.4).

...The bicyclist was David Bono, a partner at Harkins Cunningham, who was on his usual bike commute to work at 1700 K St. N.W. when he witnessed the accident.

As he traveled east on K Street, crossing 18th, Bono said "a black Corvette convertible with top closed plows into the guy. The guy is sort of splayed into the windshield.”

Bono said that the pedestrian, who was crossing the street on a "Walk" signal and was in the crosswalk, rolled off the windshield and that Novak then made a right into the service lane of K Street. “This car is speeding away. What’s going through my mind is, you just can’t hit a pedestrian and drive away,” Bono said.

He said he chased Novak half a block down K Street, finally caught up with him and then put his bike in front of the car to block it and called 911. Traffic immediately backed up, horns blaring, until commuters behind Novak backed up so he could pull over.

Bono said that throughout, Novak "keeps trying to get away. He keeps trying to go.” He said he vaguely recognized the longtime political reporter and columnist as a news personality but could not precisely place him.

Finally, Bono said, Novak put his head out the window of his car and motioned him over. Bono said he told him that you can't hit a pedestrian and just drive away. He quoted Novak as responding: “I didn’t see him there.”...

Novak is wealthy, but it's bad luck to run over a lawyer on K street and be witnessed by another lawyer. His best defense will be to plead dementia. He's on record as hating pedestrians, I bet he's not to keen on bicyclists either.

Update: Novak has a brain tumor. Which may explain a lot about why he hit a pedestrian, and why he behaved irrationally afterwards.

Wednesday, July 23, 2008

My guess is that MobileMe and iPhone 2.0 will never work properly with OS X 10.4.

So I need to upgrade my iMac to 10.5. I'm a little apprehensive because this is a PPC machine and I'm not sure how well behaved 10.5 is on PPC. Still it works well on my MacBook. Anyway that's not the real problem.

The real problem is that my ancient copy of MoRu tells me I've 661 MORE 3.1 documents on this drive. MORE 3.1 needs MacOS 9 Classic, and 10.5 doesn't run classic.

I looked at a few of my old files. There's a lot of knowledge in there I don't want to lose.

Inspiration and OmniOutliner Pro will open these as outlines, but both will lose presentation graphics. Brad Pettit's free XML converter will switch the files to plain text XML, and I think it might be able to process multiple files at once. Otherwise I can open each one and save it to another obsolete file format, or I can use CUPS-PDF to create a PDF output classic can see.

If we add in purchasing a $1,000 to $3,000 of hardware every year (average), plus software, services (MobileMess and probably 5-7 other recurrent service bills) and infrastructure costs, I suspect our communication and computing budget is larger than our gasoline budget (though smaller than our total transportation costs).

My sense is these costs are rising at least as fast as the cost of gasoline. Sure, so are the capabilities, but in general the capabilities don't have direct revenue attached.

It puts the gas price rises in a slightly different light -- there are many new expenses competing for the modern household budget.

Tuesday, July 22, 2008

.... Starting today, you can tell Google Maps that you want walking directions, and we'll try to find you a route that's direct, flat, and uses pedestrian pathways when we know about them. Just get directions as you normally would. If you're going 10 km or less (some call this 6.2 miles), we'll show you a link that you can click to get 'Walking' directions...

If you're an urban skater, however, these are a good guide for skate transit. (When pedestrians are present, it's not hard to either use the street or stand aside while they pass.)

If you're a bicyclist, they're a tip-off to roads that might be pleasant to bicycle.

I fully expect Google to start integrating bicycle paths into Google Maps, it's the obvious next step and we know they have a lot of cyclists on staff.

...Mice on the drugs generally remain healthy right until the end of their lives and then just drop dead...

Yep, that's the medical ideal. The only caveat being that we'd like a month or so of disability, so family members get to say good-bye. Dropping over suddenly is not so good for families.

Ironically, since there's no FDA approval process for compressing debility, the goal of current Sirtuin drug studies is to show a delayed onset of some chronic condition. Of course compressing debility ought to do that, even if life itself does not lengthen. If nothing else, delay the onset of diabetes and osteoarthritis.

Emily knows that when I received a podast invite from Jon Udell I yipped out loud. I’m a longtime fan of Jon’s writing and thinking; it’s timeless work. His writing from ten or fifteen years ago is still very relevant today.

The podcast is online. I’m going to make myself listen to it, though I have the not unusual aversion to hearing myself speak.

Although I’ve conversed online with John …. since my days at BYTE, we’ve never met, and we had not even spoken on the phone until last week when he joined me on an episode of my Interviews with Innovators podcast…

Jon interviewed me under my not-so-top-secret true name, rather than my John Gordon pseudonym. So if you follow the link you can learn the name I answer to.

The odd thing about the interview is that Jon’s voice and manner seemed very familiar. He writes as he is – curious, enthusiastic, smart, open, friendly and a pleasure to talk with.

We covered a bit of ground, so I’ve tagged this post with some of the topics we discussed.

Sunday, July 20, 2008

...'The Los Angeles Times reports that an Arizona crime lab technician found two felons with remarkably similar genetic profiles, so similar that they would ordinarily be accepted in court as a match, but one felon was black and the other white. The FBI estimated the odds of unrelated people sharing those genetic markers to be as remote as 1 in 113 billion. Dozens of similar matches have been found, and these findings raise questions about the accuracy of the FBI's DNA statistics. Scientists and legal experts want to test the accuracy of official statistics using the nearly 6 million profiles in CODIS, the national system that includes most state and local databases. The FBI has tried to block distribution of the Arizona results and is blocking people from performing similar searches using CODIS. A legal fight is brewing over whether the nation's genetic databases ought to be opened to wider scrutiny. At stake is the credibility of the odds often cited in DNA cases, which can suggest an all but certain link between a suspect and a crime scene.'

The FBI's fondness for lie detectors and watch lists, not to mention abundant stories of incompetence over the past decade, gives them zero credibility. Not quite the negative credibility of the Bushies, but zero.

I believe they're guilty, and hiding their guilt. The testing is not as specific as they claim, perhaps because there crime labs are incompetent, perhaps because truly accurate tests cost more than they want to spend.

Ad-supported software has to get us to look at the ads. If we stop looking, it will get more and more obnoxious. Data Lock helps ensure we can't escape, even as the pain level rises.

Software as a service has technical issues (Gmail was down a few days ago - again), but, above all, Data Lock is a terribly strong temptation. At least on the desktop there are local files that conversion software might run against.

...while all three models suffer the Data Lock temptation, it's strongest in the "Software as Service" model...

....It's happened to all of us: We sign up for some online account, choose a difficult-to-remember and hard-to-guess password, and are then presented with a 'secret question' to answer. Twenty years ago, there was just one secret question: 'What's your mother's maiden name?' Today, there are more: 'What street did you grow up on?' 'What's the name of your first pet?' 'What's your favorite color?' And so on.

The point of all these questions is the same: a backup password. If you forget your password, the secret question can verify your identity so you can choose another password or have the site e-mail your current password to you. It's a great idea from a customer service perspective -- a user is less likely to forget his first pet's name than some random password -- but terrible for security. The answer to the secret question is much easier to guess than a good password, and the information is much more public. (I'll bet the name of my family's first pet is in some database somewhere.) And even worse, everybody seems to use the same series of secret questions.

The result is the normal security protocol (passwords) falls back to a much less secure protocol (secret questions). And the security of the entire system suffers.

What can one do? My usual technique is to type a completely random answer -- I madly slap at my keyboard for a few seconds -- and then forget about it. This ensures that some attacker can't bypass my password and try to guess the answer to my secret question, but is pretty unpleasant if I forget my password. The one time this happened to me, I had to call the company to get my password and question reset. (Honestly, I don't remember how I authenticated myself to the customer service rep at the other end of the phone line.)

Which is maybe what should have happened in the first place. I like to think that if I forget my password, it should be really hard to gain access to my account. I want it to be so hard that an attacker can't possibly do it. I know this is a customer service issue, but it's a security issue too. And if the password is controlling access to something important -- like my bank account -- then the bypass mechanism should be harder, not easier.

Passwords have reached the end of their useful life. Today, they only work for low-security applications. The secret question is just one manifestation of that fact.

I think the lesson is that even when something is an "ex-parrot" humans will keep it propped up in the corner for a very long time. I used to follow Schneiers "random answer" technique, but then some sites started asking me both my regular password and my "secret question".

...Unfortunately, we don't have An App Store, we have The App Store. The difference is exclusivity. With An App Store, software can be put on the iPhone through some other method. The App Store, however, is the sole way to get software on the iPhone. This leads to some major problems all around. Users who want software that Apple doesn't approve of can't get it, because it's obviously not listed by Apple in the App Store. Developers who aren't accepted into Apple's program, for whatever reasons, can't get on the iPhone at all and thus can't sell to customers. Developers who are accepted are still running into immense issues with updates, bug testing, and more. Ultimately, that's bad for Apple too, as it means those users and developers are unhappy and will aim their frustrations squarely at Apple.

Presumably, Apple has considered all this. If so, they've determined that they'd rather have complete control over the applications available on the iPhone than have more flexibility for developers and customers alike. I can see how this could be good for Apple itself - a dictatorship tends to serve the dictator quite well. I can't, however, see why developers would support it, nor customers...

Android, Please get well soon. We Apple customers need you give the gift of Fear to Apple.

Outside of the obituary and Africa coverage, The Economist is a pale shadow of its former excellence. On occasion, however, it can rise to old standards.

A recent review of the American mortgage crisis, Fannie Mae and Freddie Mac | End of illusions, is the best I've seen. Of course it would have been even more impressive had they pointed out the structural problems a year or two ago!

With our newly enhanced vision, Fannie and Freddie look like a classic Ponzi scheme, effectively able to issue their own debt. Their ultimate downfall came when they figured out how to evade the last vestiges of old regulation by investing in mortgages they themselves could not hold.

The emerging consensus of the economists I read is that the financial markets are now in the biggest mess since 1932, however the rest of the economy is not expected to relive the great depression. On the other hand, the Economist article ends with a curious note:

... Perhaps it is no surprise that traders in the credit-default swaps market have recently made bets on the unthinkable: that America may default on its debt.

...This may help explain, for example, the success of the advice that back specialists now commonly give. Work through the pain, they tell many of their patients, and, surprisingly often, the pain goes away. It had been a mystifying phenomenon. But the picture now seems clearer. Most chronic back pain starts as an acute back pain—say, after a fall. Usually, the pain subsides as the injury heals. But in some cases the pain sensors continue to light up long after the tissue damage is gone. In such instances, working through the pain may offer the brain contradictory feedback—a signal that ordinary activity does not, in fact, cause physical harm. And so the sensor resets....

The ideas aren't quite as novel as Gawande suggests. I recall fifteen years ago veteran physicians, with lots of experience with intractable pain and chronic fatigue, had begun to think the problems were "all in the patient's head". By which we meant, with intentional irony, that the problem was "malwiring" of the brain.

The good news is, the brain is plastic. We can't easily alter it directly, but we can slowly reprogram it through the mind. That's how the mirror-box therapies Gawande describes work, and presumably that's how exercise therapy works for chronic fatigue syndrome (albeit both imperfectly).

We'll get better at this 'rewiring by programmed experience' techniques, but we're also going to have to sometimes rewire directly -- with microfilament implants and with the grosser neurosurgical techniques sometimes used for intractable seizure disorders.

Recharge times are six hours. It's a pure assist system, there's no power regeneration. A computer controlled transmission system adjusts energy input.

I like this idea. It's not hard to imagine a $1,000 version in a few years better optimized for higher speeds (drop bars, recumbent design, etc.). A recumbent tricycle version with some shielding could make rain or snow conditions tolerable for the average reasonably fit person.

Development is active in Europe and China; but if our gas prices go to $8 a gallon we'll be doing development here too.

Ok, so they're not quite as bad as a naked middle-aged emperor, but they still hurt the eyes.

The problem is they try to reconcile two different risk models. One risk model attempts to stratify people based on their similarity to a large population study - the Framingham model.

Another risk model is based on different research data sets, and tries to estimate risk based on a changing set of predictive "risk factors", such as Diabetes mellitus, and family history of heart disease.

Problem is, those two latter two big risk factors weren't a part of the Framingham model. In fact the Framingham model doesn't incorporate LDL cholesterol directly, it estimates it from Total and HDL cholesterol.

The two models look like this (table stolen from my obsolete online medical notes, this part was updated):

Item

Risk calculation model

Risk factor approach

Age

x

x

Gender

x

x

Total Cholesterol

x

HDL Cholesterol

x

x

LDL Cholesterol

x

Smoker

x

x

Hypertension

x

x

Family history

x

Diabetes

x

The guideline writers try to glue the two models together in a way that seems logical, but they really don't work that well. For example (LDL level in this table is the level where the statins start).

LDL Level

Risk Factor

Framingham 10 yr risk

> 100

CHD or "equivalent"*

> 20%

> 130

2 + (ex. 46 yo male smoker)

10 - 20%

> 160

2 + (ex. 46 yo male smoker)

< 10%

> 190

Treat based on LDL alone.

I played around with the online calculator, it wasn't hard to create a plausible patient with a Framingham risk of < 10% but a Risk Factor Model if CHD equivalent (basically a healthy diabetic patient, the right answer is clinical judgment with a bias towards treating if either of the risk models meet criteria. So treat if column A + either (B or C).

We really need a single integrated model of risk, not trying to juggle and compare two different models that can give contradictory answers.

Of course it may turn out that this single integrated model doesn't lend itself to memorization, but needs to be implemented as an electronic tool. Wouldn't be the first time that's happened.

The Loom's "Festooning The Tree Of Life" tells how biologists have visually represented the history of E. Coli gene transfer. It's an example of "scientific visualization" and knowledge representation that belongs to any class or course on visualization and representation -- not to mention a future Tufte book.

The watch list is a corollary to the worthless no fly list. There used to be a TSA form to ask for removal from the no fly list, but the old link doesn't work any more. More recently the Traveler Redress Inquiry Program (TRIP) appeal program was recently reviewed by MSNBC (emphases mine):

... As of January 2008, some 24,000 people had used TRIP to appeal their inclusion on the lists. The TSA hasn’t revealed how many applicants have been officially cleared or whether clearance has actually resulted in no-hassle flying. Anecdotal reports from frequent fliers maintain that many travelers who were told they were cleared continue to be stopped in airports.

The TSA press office in Washington, D.C. declined to take questions about TRIP from an Aviation.com writer, referring the writer to TSA spokesman Nico Melendez in Southern California. Melendez didn’t return the reporter’s telephone call or reply by e-mail for this story.

In past years, TSA spokespeople suggested that aggrieved travelers contact the TSA ombudsman to set things right, but TRIP has largely superseded the earlier procedure. Perhaps that’s for the best, as the TSA ombudsman’s office has received scathingly bad reviews from TSA employees, as related by a report made public in late June by the Inspector General of the Department of Homeland Security. Complaining of poor training and tone-deaf management, some 20 percent of TSA screeners quit their jobs last year.

As it stands, TRIP consists mainly of an online form. Travelers who want to tap into TRIP should go to the TSA’s Web site, look for the "Resource Center" section on the right-hand side of the page and follow the prompts...

Physicians would recognize the Watch List as one of those stupid lab tests that come out every few years claiming to find some nasty cancer, but ends up sending vast numbers of healthy people for misguided surgical procedures.

It's another Cheney/Bush legacy that Bush III (McCain) will institutionalize.

The ACLU's response is rational and similar to regulations for cleansing credit reports ...

due process

a right to access and challenge data upon which listing is based

tight criteria for adding names to the lists

rigorous procedures for updating and cleansing names from the lists.

Of course if the FBI actually followed those rules the list would be revealed as a worthless waste of money and a source of security-reducing noise.

The ACLU is doing good work. I should donate to them. Problem is, I've done that before. The ACLU has their own version of a "watch list" -- it's their "donor list". They use it to generate killer levels of paper spam (junk mail), and they sell it widely. I need a way to send plain unmarked bills to the ACLU so they can't spam me. Ideas?

....By using Sync Services, you can synchronize your Entourage contacts and calendar events with an iPod, iPod touch, or iPhone.

Sync Services is a central database on your Macintosh computer that keeps track of programs and devices that share information. After synchronizing an Entourage address book and calendar with Sync Services, the information is also synchronized with your Macintosh Address Book and iCal. Then you can use iTunes to synchronize the information with your iPod or iPhone...

Sure, that's the ticket! Microsoft could create a Task and Notes app for the iPhone, and sync with Entourage and Outlook ...

... Phil Libin was the CEO of CoreStreet when he appeared as the first guest on Interviews with Innovators. Now he's back as CEO of EverNote, a company that aims to build the memex, or personal outboard memory, that Vannevar Bush famously imagined in his 1945 article "As We May Think."...

Data Freedom is vital to our plans. We're serious about Evernote as an "external brain" and that means users have to have confidence that their memories will always be accessible. Part of that accessibility is making sure that users can import/export Evernote data in standard formats with no restrictions. Our current limitations on import/export capabilities are due to developer resource constraints, not any philosophical or business reasons; we can't afford to do import/export poorly because that could muck with your data and flood our support lines. Doing it well takes time.

We're currently testing a full set of Evernote APIs that will give people a lot of options for getting data in and out. We'll roll these out publicly later in the summer. We'll also be expanding the structured import/export capabilities on the local clients, though I don't have a specific date on that yet. We're doing this because data freedom is good for more than just peace of mind - it'll let us build lots of great functionality that we couldn't accomplish with a "walled garden" approach.

Now that I know Evernote is explicitly targeting the Memex/Xanadu vision, I'm even more interested in the product/service -- but I'm also even more demanding.

Even if I trust Mr. Libin completely after listening to the interview with Jon, it's too risky for me to adopt Evernote without a demonstrated, working, export capability. Heck, Evernote could be acquired tomorrow and Mr. Libin could retire the next day! The new owner might be more enchanted with customer lock-in than with changing the world.

Realistically, of course, almost nobody but me is really going to worry about this prior to signing up. Evernote would be silly to divert resources to accelerate import/export -- it's far more important for their market that they enhance the iPhone client.

I'm just sorry I won't get to play with them until they have an export tool. I'll be watching closely though ...

* I'm a longtime fan of Jon Udell's, and I recently had the pleasure of chatting with him. Oddly enough, he sounds exactly the way I'm imagined.

...If the US infant mortality rate were equal to first-ranked Sweden, more than 20,000 babies would survive beyond their first year of life...

Most powerful army though, so we could always conquer Sweden and improve our numbers. Heck, last time I looked my Canadian homeland could probably be taken by the National Guard.

Thank heavens for Russia, we're probably ahead of them.

This is a deep hole. We have a cultural problem here that will take generations to fix.

A part of the fix will be to develop a political system with two respectable alternatives. That means getting the GOP out of power completely so it can reform itself or be replaced by another, healthier, party.

The video for adding a location is very short. It consists entirely of "We're sorry, this video is no longer available".

What's with all the #$!$ video? I admit, a brief screencast can work very well, but these take way too long to load and view. A few words would be much less trouble to prepare and update, more reliable (see above), and it would be much faster and easier to process. Not to mention that words can be indexed (hint for Google - I thought you did search?).

There's a mania now for video display. I haven't seen this noted anywhere, nor have I seen any explanation of why video has taken over. (Yeah, sure, we all think it's the fault of those dang-gummed video games.)

I'm hoping it's a silly fad, and that we'll eventually settle down to a more appropriate mixture of text and screencasts.

I can't imagine getting away from the Bush regime. In my bones I feel the US will elect Bush III (aka McCain). If, by a miracle, Obama does win ... well, it will be like awakening from a long nightmare.

It used to be I sent email to the person on the To: line, and maybe to a small, carefully selected, group on the CC line.

That's still true, but there's a new recipient for every email -- my future self. The message is an encapsulated bit of knowledge about people, time, subject, body and, sometimes, tags. The subject line describes the message and tasks for my recipients, but it also supports future retrieval and interpretation.

I've been doing this for years now, and I'm getting better at writing for the current and future audiences. I put in a small amount of extra context -- maybe not necessary for the moment, but invaluable for far future interpretation. Every subject line is considered in terms of future selection. "Tomorrow" becomes a specific date, keywords are worked into the description, I clean up mail threads to make them more useful on retrieval, I make subject lines unique. Every month I add a new tweak of one kind or another.

So now my email is still a message, but it's also a post into multi-GB knowledge base. It's becoming a core part of my memory.

That's where the curious bit happens. I said I've been doing this for a while.

It's changing the way my mind works. A lot of what used to reside in my head now lives only in the repository. My head is full of pointers, references, retrieval strategies, tags and fragments, but it's not so solid as it was. When I have the repository I have a far better memory than I've ever had, but when I don't have it I feel partly disabled.

Maybe I'm more susceptible to this than most -- I've always had an associative graph memory rather than a structured hierarchy. I suspect I'm not alone in my increasing reliance on digital prostheses however.

On the one hand, I thought the 9% approval rating for Congress was absurd. The Democratic Senate has blocked a lot of harm, and started the multi-decade cleanup that may continue if Obama is elected. Since the Dems need some GOP support to get by filibusters and a Bush veto, the scope for action is necessarily limited.

A recent poll of Americans turned up the fact that just nine percent approve of the job the present Congress has been doing...

I consulted the online calendar of the House of Representatives for the day I write this, Friday, July 11, and found that the House was in recess. They’ll be back to work on Monday, they promise, though not until 12:30 in the afternoon. The day before, it seems that the bulk of the day was spent discussing the creation of a new historic trail commemorating something from the Revolutionary War. A bit of time was given over to congratulating NASA for some anniversary, and some more time to something to do with flood insurance. Heady and very patriotic stuff, to be sure.

Over in the Senate, David Vitter – he whose phone number somehow got into the hands of the so-called “D.C. Madame” – and Larry Craig – he of the unfortunate “wide stance” in men’s rooms – are cosponsoring a “Marriage Protection Amendment” to the Constitution. Mere ridicule fails before such gall. I doubt that even that master of political shiv work, Mort Sahl, could have adequately satirized these two buffoons...

... Now, it’s unfair, I know, to criticize on the basis of one day’s record of floor proceedings in the House. There are committee hearings – on major league baseball, for example – and staff work and constituent assistance and such things going on in the background. And fund-raising, Lord knows. My local newspaper carries a report on the recent activities of our congresspersons which can be summarized thus: No sweat.

So let’s go to the tape:

Health care: Nothing

Social Security: Nada

Energy policy: Zip

Immigration: Bupkes

Earmarks: You kidding?

It could be argued that we the citizenry are actually better off for congressional inaction. This might well be true but for the fact that inaction now simply leaves in place the bad policies already on the books. Having mandated that gasoline contain a certain proportion of ethanol, for example, certainly counts as a stab at an energy policy, while forbidding the import of cheap sugar-based ethanol in favor of the domestic kind, which drives up the price of corn and myriad other corn-based food and non-food products, counts as reelection-inspired stupid policy.

It's an interesting list of inactive topics. Here's my take at why nothing can happen, and as usual the fault is not Congress. In fact, it's not even all the GOP's fault. The fault lies in us:

Health care: Dems can't override a Bush veto. So nothing can happen here. Real reform will either increase taxes or redistribute costs among health care consumers, so it can only be done at the start of year one of a 2nd Obama term. (Seriously, real reform is at least that far away. America is not ready for how much this will hurt. The fault is ours.)

Social Security: Social security needs important tweaks, not an overhaul. Health care is the problem. The author has bought into Bush propaganda. Invest in dementia prevention research.

Energy policy: The Bush problem, again. This could improve in year one of a first Obama term.

Immigration: Too close to an election, and we need much more national discussion. This will get addressed after the election, no matter who wins.

... These hacker groups seem not to be working for the Chinese government. They don't seem to be coordinated by the Chinese military. They're basically young, male, patriotic Chinese citizens, trying to demonstrate that they're just as good as everyone else. As well as the American networks the media likes to talk about, their targets also include pro-Tibet, pro-Taiwan, Falun Gong and pro-Uyghur sites.

The hackers are in this for two reasons: fame and glory, and an attempt to make a living. The fame and glory comes from their nationalistic goals. Some of these hackers are heroes in China. They're upholding the country's honor against both anti-Chinese forces like the pro-Tibet movement and larger forces like the United States.

And the money comes from several sources. The groups sell owned computers, malware services, and data they steal on the black market. They sell hacker tools and videos to others wanting to play. They even sell T-shirts, hats and other merchandise on their Web sites.

This is not to say that the Chinese military ignores the hacker groups within their country. Certainly the Chinese government knows the leaders of the hacker movement and chooses to look the other way. They probably buy stolen intelligence from these hackers. They probably recruit for their own organizations from this self-selecting pool of experienced hacking experts. They certainly learn from the hackers...

Essential reading. Schneier is a fellow Minnesotan, btw.

Mercifully, these young men don't have Macs.

[1] BTW, as Gibson points out, there are no cell phones in Neuromancer -- or Idoru for that matter. It's very hard to write predictive near future science fiction. Of course in Heinlein's "Citizen of the Galaxy", which was really science fantasy/space opera, computer output is on paper strips ...

I get frustrated because of things like Google's broken Outlook synchronization, or their non-existent task/calendar integration, or a dozen other things I'd like to see them do with gCal and, even more, with Google Apps.

What do they do with their time and money?

Well, among other things, they deal with the consequences of a worldwide customer base:

Language support is feature 0 for most users (excluding the Dutch, who all speak and write six languages from birth). On the other hand, a port to Chinese doesn't get my Outlook 2003 sync working.

Obviously, Google needs to do this work. A port to Chinese is a thousand times more important in terms of human value and Google's future than fixing Outlook Calendar sync.

It is interesting though, to consider the consequences of having a worldwide support task. It suggests new features will be deployed with increasing care and deliberation - no matter how much development money is available. Software development does not scale linearly with resources, as Microsoft has amply shown. At some point a extra billion dollars buys only a small increment in functional improvement.

I wonder if Google's global burden will open opportunities for less constrained competitors...

... the environment committee of the Spanish Parliament last month to grant limited rights to our closest biological relatives, the great apes — chimpanzees, bonobos, gorillas and orangutans.

The committee would bind Spain to the principles of the Great Ape Project, which points to apes’ human qualities, including the ability to feel fear and happiness, create tools, use languages, remember the past and plan the future...

If the bill passes — the news agency Reuters predicts it will — it would become illegal in Spain to kill apes except in self-defense. Torture, including in medical experiments, and arbitrary imprisonment, including for circuses or films, would be forbidden.

The 300 apes in Spanish zoos would not be freed, but better conditions would be mandated...

... Mr. Singer ... left out lesser apes like gibbons because scientific evidence of human qualities is weaker, and he demanded only rights that he felt all humans were usually offered, such as freedom from torture — rather than, say, rights to education or medical care.

... even in democracies, the law accords diminished rights to many humans: children, prisoners, the insane, the senile. Teenagers may not vote, philosophers who slip into dementia may be lashed to their beds, courts can order surgery or force-feeding.

Spain does not envision endowing apes with all rights: to drive, to bear arms and so on. Rather, their status would be akin to that of children.

... Spain’s Catholic bishops attacked the vote as undermining a divine will that placed humans above animals. One said such thinking led to abortion, euthanasia and ethnic cleansing...

If we're still around fifty years from now, this will be an obscure event on a history exam, with the context of "of course this is obvious".

It's a more than mildly interesting question.

Eons ago I wrote an ambitious essay for a philosophy class; I attempted to create a species-neutral mechanism for assigning rights and privileges. Every scheme I came up with, and those I've read since, had uncomfortable consequences. It wasn't merely that one ended up giving lesser rights to my species than to better behaved robots and aliens, the rights of many impaired humans overlapped with not only apes, but also cats, dogs and squirrels.

In a later medical school essay I accepted the inevitable, and wrote that all ethical systems are merely post-hoc explanatory frameworks for enforcing and extending biologically and culturally evolved mores. The species-specific assignment of rights then is not a challenge to reason, it's merely politics.

Still. Many things that were once accepted mores are now despised. Even the homophobia of my youthful culture is passing into the night.

We know the road we're going down. If our civilization survives, sometime in the next century we'll grow our protein from tissue cultures, not from animals.

... I've long had an information-geek's admiration for the printed version of Monthly Prescribing Reference. Despite its evil ad-funded roots, there's a real genius to the density and layout of the content, refined by generations of customer feedback. It also has the virtue (and sin) of being always topical and exceedingly brief.

So I started my review by reading this cover to cover. Each time I come across a medication that's new to me, or a familiar one that unlocks a domain of forgotten knowledge, I add it to my core med review sheet. This sheet is also an interesting overview of what's changed in medicine over the past decade. There was more activity in the treatment of Parkinson's Disease, for example, than I would have guessed...

Other than observing the desperate attempts to find something Tumor Necrosis Factor inhibitors are good for, I was struck by the explosion of combination meds.

What explains this? Is it patient demand? Is it pharma desperation due to a shrinking development pipeline?

It was Emily who suggested a motivation that could explain the development all by itself.

Medication co-pays.

The most common co-pay schemes strongly incent patients to minimize the number of their chronic prescriptions, with much less incentive to minimize the cost of prescriptions. On the other hand, combination meds are very profitable for pharmaceutical companies.

I suspect the payors who designed co-pay schemes didn't have have these outcomes in mind.

... While there was no relationship between brain size and exercise in people tested who did not have Alzheimer's, Dr Burns said the four-fold difference in those who did was evidence that exercise might help.

He said: 'People with early Alzheimer's disease may be able to preserve their brain function for a longer period of time by exercising regularly and potentially reducing the amount of brain volume lost.

... To directly test the possibility that exercise (in the form of voluntary running) may reduce the cognitive decline and brain pathology that characterizes AD, the study utilized a transgenic mouse model of AD rather than normal mice. The transgenic mice begin to develop AD-like amyloid plaques at around 3 months of age. Initially, young mice (6 weeks or 1 month of age) were placed in cages with or without running wheels for periods of either 1 month or 5 months, respectively. Mice with access to running wheels had the opportunity to exercise any time, while those without the wheels were classified as “sedentary.”

On 6 consecutive days after the exercise phase, the researchers placed each mouse in a Morris water maze to examine how fast it could learn the location of a hidden platform and how long it retained this information ... the mice that used the running wheels for 5 months took less time than the sedentary animals to find the escape platform. The exercised mice acquired maximal performance after only 2 days on the task, while it took more than 4 days for the sedentary mice to reach that same level of performance...

Still voluntary exercise. I'd have preferred they forced the mice to exercise, say a treadmill that dumps the non-runners into water.

So mark me down as cautiously optimistic, though very puzzled about mechanism.

At present I'll grant a 40% probability that exercise will really slow the inevitable [1] onset of Alzheimer's -- presuming the exercise isn't associated with head injury risk. (So my inline skating hobby is not a preventive measure.)

Even at a 40% 'might help' that's a much higher protective probability than anything else I've heard of other than avoiding head injury [2].

[1] Live long enough, you get Alzheimer's -- along with vascular dementia. Genetics, head injury and (perhaps) exercise only determine the speed of decline.[2] I classify the modern enthusiasm for live combat right up there with the 1970s enthusiasm for snorting coke.